| NPI | 1487210399 |
|---|---|
| Other Name | JACK JACKSON |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 297949) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 280595) |
| Enumeration Date | 2019-05-15 |
| Last Update Date | 2025-10-30 |